Managing food security in a predominantly rural economy such
as Pakistan's requires an understanding not only of how
agricultural policies affect food supply and incomes but also of
how households acquire food and cope with insecurity. Many
economists regard income as the main indicator of welfare, but
other planners maintain that food consumption, health, and
nutrition of household members are also important in defining a
household's standard of living. The main concern of this research
is to trace the pathways from economic and social policies to
food security and, ultimately, to nutrition. In effect, the
report considers how income is best converted into nutritional
well-being. Snapshot approaches- those that look at one point in
time-have various uses in understanding these processes but are
limited in that they do not reveal anything about the actual
dynamics of poverty and food security and their consequences for
nutrition and health. This report addresses these concerns by
looking at longitudinal data for a three-year period, 1986 to
1989, and analysing the fluctuations in incomes, consumption,
saving, nutrition, and health-seeking behaviour of 800 households
in five districts in rural Pakistan.

Although the sample households are all located in rural areas,
their sources of livelihood are not strictly agricultural.
Diverse sources of income other than crops and livestock are
found, including artisan work, village crafts, operation of
public conveyances, and different forms of trading activities.
Moreover, many households receive substantial remittances from
household members working in large Pakistani cities such as
Karachi or abroad (the Middle East, for example). Together,
non-farm income accounts for nearly 45% of total income,
including transfers such as remittances and pensions. Much of the
rural non-farm income is from self-employment, unskilled labour,
or business activities such as production of inputs or processing
of agricultural output and therefore is a natural outgrowth of
crop and livestock productivity. Hence, strategies for rural
development should involve a much broader array of policies than
agricultural development per se, including the broadening of
credit to non-farm enterprises, improvement of infrastructure,
and expansion of rural education.

Income inequality is quite high in the rural areas. An overall
Gini coefficient (a measure of income inequality) of 0.40 is
calculated for these populations, compared with 0.75 when land
ownership is used as a measure of wealth. Of the five sources of
rural income-agriculture, livestock, non-farm, rental, and
transfers-agricultural income accounts for the largest share of
overall income inequality. On the other hand, income from
livestock and non-farm sources helps decrease income inequality.
These findings indicate that policies that seek to promote
livestock development and to attract non-farm investments in
rural areas are likely to promote better distribution of income
in Pakistan.

Fluctuations in income, even over the relatively short
three-year period, were considerable. Weather, illness, and
decline in remittances from abroad were among the reasons. This
study finds that a moderate share of income fluctuation is
explained by district variables and a far greater share by
village-level variables. Consumption risks in these households
were only partially mitigated by sharing through family networks.
Savings played a major role in smoothing consumption. Income
risks were also reduced by diversification of income sources.

On average, 70% of a short-run increase in income is either
saved or used to pay off the debt, and even low-income households
manage to save half, although net physical savings of only about
10% are attained because the rest is usually channelled to
repayment of debt. Surprisingly, in these rural settings,
households use formal financial instruments such as bank savings
accounts to channel half of the remittances from family members
abroad. Remittances are mostly saved, and the rest (about 30%)
are channelled into physical property, mostly for housing and
physical improvements.

According to this study, fluctuations in income do not
translate into fluctuations in calorie intakes in the rural
households, however. No evidence of seasonality in consumption is
detected in 12 separate observations. Even the shift from eating
rice to wheat, which occurs in some areas because their harvest
times are different, does not affect total calorie intakes. The
households surveyed for this study generally have a higher
calorie supply per capita than in most parts of South Asia. They
cope with seasonal lows and higher food prices through savings,
including storage of grains. Credit-mostly from the informal
sector, such as friends, relatives, and local stores helps
maintain a fairly constant expenditure level.

Calorie-income elasticities in the sample households ranging
from 0.12 to 0.39 imply that it would take, on average, about a
30% rise in income to achieve a 10% rise in calorie consumption.
Thus, underconsumption of calories in the poorest households is
unlikely to disappear in the normal course of economic
development. The study, however, also finds that food expenditure
elasticities are 1.5 to 2.0 times higher than calorie
elasticities, indicating that as household incomes increase,
diets are diversified with higher-quality foods, not necessarily
with larger quantities of food.

Other policies to attain higher levels of food security need
to be found. One possibility is investment in the education of
women, who play a critical role in determining household food
acquisition patterns. Education of women is found to be a key
factor in achieving better nutrition. Educating women to at least
the primary level is likely to be nearly three times more
effective than increasing incomes by 10%. Clearly, public
investments in education for women will have a very high pay-off.

But this study also finds that increases in calories will not
automatically translate into better nutrition and health in
children unless the high rates of infection are addressed. The
low association between calorie intake and child nutrition found
in many past studies was primarily due to the failure to consider
the interaction between diet and disease. In an environment such
as the rural area in this report, where disease is widespread,
the role of infection is often magnified. Diarrhoea and illness
strongly determine the nutrition status of the preschoolers.

The nutrition status modelling in this study indicates that
critical community services-including health services,
sanitation, village water supply, and public drainage systems-are
necessary to stem the spread of infectious diseases. Public
health programmes that reduce illness, such as immunization, or
those that encourage prenatal care are important instruments for
influencing nutrition. However, the mere physical presence of the
services in a community is not enough: quality of services is
equally important. For the most part, households cannot provide
these services from their own resources. Support from the
government for the provision of such critical community services
is essential.

Malthus never fully anticipated the miracles of technological
innovation, which, despite population doubling and re-doubling
have so far kept at bay the threat of food supplies falling below
the level where life can be sustained. Instead, the 1980s saw a
near balance in growth of population and per capita food
production in many regions; in fact, for the world as a whole,
per capita food production increased by 5%. Yields of major
cereals have more than doubled in the past few decades.

As a consequence, marvelling at the miracle of the "green
revolution" has given way to a complacent assurance that
technological innovation will always be able to conjure up
adequate supplies to feed a growing population. Many countries
and institutions have even begun to cut back their investment in
the very agricultural research that made it possible to feed the
world in the past.

In World Food Trends and Future Security, IFPRI
Director General Per Pinstrup-Andersen looks at recent world food
trends and asks if the positive production trends of the past 30
years are likely to continue. Or, as 100 million new people are
added to the world's population each year, will Malthus's
prediction of increasing food scarcity come true? Will food
scarcity, hunger, and disease related to malnutrition become even
more widespread in the next 20 to 30 years?

Overall positive trends disguise wide disparities in
production and distribution of food among regions. Today more
than 700 million people in developing countries do not have
access to sufficient food to lead healthy, productive lives. More
than 180 million children are underweight. As many as 500,000
preschool children go blind each year as a result of vitamin A
deficiency. Lack of micronutrients such as vitamin A and iron not
only causes suffering and death but also cuts deeply into
productivity. Through research and policy, diets could be changed
to eliminate much of this suffering.

Although enough food is now being produced to feed everyone if
it were evenly distributed, access to adequate food is largely
governed by income. Of the 1.1 billion poor people in developing
countries in 1990, 50% were in South Asia, 19% in sub-Saharan
Africa, 15% in East Asia, and 10% in Latin America. In South Asia
and Africa, 50% of the regions' populations live in poverty.
While significant reductions are expected in both South and East
Asia, the poor in Africa are expected to increase by 40% by the
year 2000.

Although food production increases of 30% in the 1980s seem
impressive, they are less so in the light of population growth,
On a per capita basis, 75 developing countries produced less food
per person at the end of the 1980s than at the beginning. Except
in Africa, 80% of the production gains came from increased yields
in major cereal crops. The area cultivated has actually begun to
decline in some regions. From now on, however, even Africa, which
has always relied on cultivation of new land for production
increases, will have to count on yield gains or pay high
financial and ecological costs for expansion into areas not yet
cultivated.

Yield trends have climbed steadily upward in all major cereals
since the 1960s, but some experts detect a tapering off. In
China, for example, rice yield growth rates have slowed more than
4% a year in the late 1970s to about 1.6% a year during the
1980s. Stagnation between 1980 and 1993 in per capita grain
production in developing countries is causing concern because
factors in addition to population growth are pushing up demand.
Expected growth in world feed-grain demand is more than twice the
expected population growth.

For more than 50 years food supplies have been sufficient to
assure that international food prices increased less than other
prices. Recent projections indicate that real food prices are
unlikely to increase significantly during the remainder of the
1990s. Low food prices in the world market do not necessarily
mean that more people will be fed, however. Poor people cannot
express their demand for food, because they cannot afford to buy
it. More than 1 billion people live in households that earn less
than a dollar a day per person. Clearly, they are not in a
position to convert their food needs to effective market demand.
Since price is a product of both food supplies and economic
demand, low prices indicate the persistence of poverty and a lack
of sufficient purchasing power as well as increasing food
production.

If a sustainable balance between world food production and
food needs (as opposed to food demand) is to be achieved in the
coming years, four conditions must be met: (1) economic growth
must resume in the developing world, especially in sub-Saharan
Africa; (2) effective policies to reduce population growth and to
slow rural-to-urban migration must be adopted; (3) resources must
be committed to development of rural infrastructure, to
continuation of international and national agricultural research,
and to provision of credit and technical assistance to give
farmers access to modern inputs; and (4) measures must be
developed to manage natural resources and to prevent
environmental degradation.

At this point, international real food prices are low, food
surpluses exist in developed countries, and there is reason to
believe that former Soviet Union countries will increase their
food production in the decade to come. Yields of wheat, rice, and
maize are still increasing in Asia and parts of Latin America
although at a lower rate than before. All of these positive signs
have caused developed countries to reduce their support for
developing-country agriculture, including investment in research
and technology.

Although the overall picture is bright, about 700 million
people are food-insecure today, and tomorrow does not look so
promising. Population in sub-Saharan Africa is expected to grow
at 3% a year and food production at less than 2 %. If current
trends in population growth and food production continue, the
World Bank estimates that by the year 2020 Africa will have a
food shortage of 250 million tons. And poverty and the numbers of
underfed children will grow accordingly. Though less severe,
shortages are also likely in South Asia. At the same time, large
areas of land are being degraded and deforested, largely due to
poverty, population growth, and limited access to appropriate
technology.

Now is not the time for complacency. Malthus's predictions
have failed to materialize so far because science has been used
to expand food production. Failure to invest in agricultural
research today will show up in production shortfalls 10 to 20
years from now. If environmental degradation continues unchecked,
shortfalls could occur much sooner. But even if food supplies
continue to be adequate to meet global demand at low prices,
complacency is not in order. Unless more food is produced by the
poor in the developing countries where large increases in
population and poverty are expected,

food insecurity and its toll in human misery will continue to
increase. To avoid future food crises, adequate investments in
the components of agricultural development such as rural
infrastructure, research, and technology must be made today.

The International Dietary Energy Consultancy Group (IDECG) was
established for the study of dietary energy intake in relation to
the health and welfare of individuals and societies. Its specific
objectives, as defined at the foundation meeting in Geneva on 3
Sept. 1986 are:

» the compilation and interpretation of relevant research
data on functional and other consequences of deficiency, change,
or excess of dietary energy intake;
» the identification of related research needs, determination of
priorities, and promotion of needed research;
» the publication of scientific and policy statements and other
information on the significance of chronic deficiencies and
excesses of dietary energy;
» the identification and promotion of appropriate and practical
means of corrective action.

To meet these objectives, IDECG seeks to bring together
scientists engaged in relevant research with representatives of
international organizations concerned with the problem. It also
seeks to involve in its work bilateral agencies, foundations, and
governments interested in relevant research and policy actions.

IDECG is sponsored by United Nations University, with the
endorsement of the UN ACC Subcommittee on Nutrition (SCN), and by
the International Union of Nutrition Sciences (IUNS). UNU
responsibility for the policies of IDECG is delegated to a
steering committee consisting of a representative of the UNU as
chairperson, the Secretary General of IUNS, and the Executive
Secretary of IDECG. Responsibility for the administration of
IDECG is delegated to the Executive Secretary.

Activities and publications

Chronic energy deficiency: Consequences and related issues

A workshop was held at INCAP in Guatemala in August of 1987 to
discuss the effects of chronic energy deficiency on behavioural
development, stature, work capacity, and productivity. Papers
were also presented on the socioeconomic consequences of and
responses to food deprivation, seasonality in energy metabolism,
the effect of energy supplementation, research on metabolic
adaptation to low energy intake, and maternal energy
requirements. The proceedings of the meeting were published as
the first volume in the IDECG series in 1987.

Activity, energy expenditure, and energy requirements of
infants and children

A workshop re-examining the energy requirements of infants and
children from the point of view of physical activity and energy
expenditure was held in Cambridge, Mass., USA, in the fall of
1989. The workshop proceedings, entitled Activity, Energy
Expenditure and Energy Requirements of Infants and Children,
were published as the second volume in the IDECG series in 1990.

Improved protein-energy Intakes in early childhood and
human-capital formation

In the summer of 1990 IDECG sponsored a workshop in Bellagio,
Italy, bringing together scientists involved in the follow-up of
a longitudinal food supplementation study in Guatemala. Data
presented at the meeting indicated that nutritional improvements
during the critical period of gestation and the first two to
three years of life can enhance human-capital formation assessed
by a wide range of variables in adolescence. A first series of
papers presented and discussed at the meeting, dealing with the
background of the INCAP longitudinal study, the supplementation
effects in early childhood, the demographic and social changes
between the two studies, and the design and main findings of the
follow-up, appeared in the Food and Nutrition Bulletin,
vol. 14, no. 3 (Sept. 1992).

A second report, entitled Early Supplementary Feeding and
Cognition: Effects over Two Decades, dealing with
supplementation effects on cognition, appeared as a monograph of
the Society for Research in Child Development (vol. 58, no. 7,
1993, serial no. 135) in the fall of 1993.

A third series of papers, focusing on the follow-up study and
presenting its results in detail is in print as a supplement to
the Journal of Nutrition.

Protein-energy interactions

In October 1993 IDECG convened a workshop in Waterville
Valley, New Hampshire, USA, to explore in depth the full range of
dietary, physiological, and pathological factors influencing the
relative demand of the human body for dietary protein, amino
acids, and energy. The workshop proceedings, entitled Protein-Energy
Interactions, appeared in 1992 as the third volume in the
IDECG series.

Functional significance of low body mass Index

IDECG and the FAO convened a meeting in Rome, 46 Nov. 1992, to
review in greater depth the functional correlates of low body
mass index (BMI) and to try to derive from this a clearer view of
the meaning and functional significance of this indicator.

The information examined at the workshop generally tended to
confirm relationships between BMI in the lower range on the one
hand and various socioeconomic indicators (such as household
income), morbidity, and mortality on the other. Relationships
between BMI, work capacity, and time devoted to work are more
consistent than those between BMI and work productivity measures,
perhaps because of the lack of a satisfactory model of the links
between BMI and work productivity.

Human lactation performance appears to be very robust, and BMI
does not provide a useful indicator of function at the levels
studied so far. Lactation performance must become compromised
when undernutrition is sufficiently severe, but it appears that
this must be in famine or near famine conditions.

The proceedings of the meeting are in print as Supplement 2,
1994, of the European Journal of Clinical Nutrition.

Causes and mechanisms of linear growth retardation
(stunting)

A workshop on this topic was held in London, 15-18 Jan. 1993.
The meeting brought together scientists who had made observations
on causes, correlates, and patterns of linear growth retardation
with experts on the cellular biology and hormonal regulation of
bone growth who could speculate on the mechanisms involved.

Workshop participants concluded that the main factors
affecting linear growth were nutrition, infection, and
mother-infant interaction. Since most stunted children are of
normal weight for height, the quality of their diet appears to be
generally more limiting than the quantity. Several studies have
suggested an effect of animal food on linear growth, but it is
not yet clear whether amino acids, micronutrients, or lipids are
the most limiting factor. Infections contribute through injury to
the gastrointestinal mucosa, leading to malabsorption,
particularly of micronutrients, and to increased permeability of
antigens and bacteria. The systemic effects of infections,
mediated by cytokines, result in anorexia and extra losses of
nutrients.

Stunting results from a delay in the growth of long bones,
which occurs in three phases. During the infancy phase, which
begins in utero, reaches its apex around birth, and then declines
until three to four years of age, the growth of long bones
depends primarily on insulin and insulin-like growth factors.
Growth hormone is in circulation in relatively large amounts, but
the receptors for it in the end organs are not expressed yet.
Around six months after birth, in a normally growing child, these
receptors begin to express themselves and the hormone becomes the
most important determinant of bone growth; this is the beginning
of the childhood growth phase. Evidence is accumulating that what
characterizes and determines stunting is a delay in the onset of
the childhood growth phase. We do not, however, know what
determines the time of the onset of this phase.

The workshop proceedings appeared as Supplement 1, 1994, of
the European Journal of Clinical Nutrition. They contain
a useful set of guidelines for scientists interested in further
study of mechanisms involved in the prevention or reversal of
linear growth retardation in developing countries.

Updating of the 1985 FAO/WHO/UNU report on energy and
protein requirements

IDECG has taken the initiative in an effort to update selected
parts of the 1985 FAO/WHO/UNU expert consultation report Energy
and Protein Requirements. To provide a basis for discussion
and decision, experts were asked to write position papers on: (1)
energy requirements: general principles; (2) energy requirements
of infancy; (3) energy requirements of children; (4) energy
requirements of pregnant and lactating women; (5) protein
requirements of infants and children; (6) protein requirements of
adults; (7) energy and protein requirements of older individuals.
These papers were discussed at an IDECG workshop held in London,
31 Oct.-4 Nov. 1994. The revised papers and the recommendations
of the workshop participants will be published and will form the
scientific basis for an FAD/WHO/ UNU consultation in 1995.

This book, developed by the IUNS Committee on Nutrition and
Development as a sequel to Nutrition and Development
(Oxford, 1984), explores new issues, including feeding urban
populations, dealing with the negative effects of environmental
pollution on health and food production, the effect of dietary
excesses with increased affluence on chronic degenerative
diseases, and communication and nutrition education. Although it
is a policy book, it contains considerable original information,
as some chapters are the product of major studies: e.g.,
nutrition and health relationships in the aged, the effect of
female-headed households in Africa and the health of mothers and
children, the effects of economic adjustment on the nutrition
status of African populations, and nutrition status in Egypt. The
opening chapter, `'Nutrition, food production, and the
environment," written by the senior editor, is particularly
comprehensive and topical. Although it will be useful to
nutritionists, it should be noted that, despite its title, the
book does not attempt comprehensive coverage of all the multiple
and complex nutrition issues in the nineties.

Despite its similar title, this is a totally different kind of
book from the one listed above. It is a concise series of
critical analyses of a series of current issues and controversies
in nutrition and health, including diet and breast cancer,
complex carbohydrates and health, the genetics of cardiovascular
diseases, the roles of low-fat diets and exercise in weight loss,
the benefits of exercise for older adults, and new developments
in nutrition research including the role of transgenic animals,
and the impact of health claims regulations under the US
Nutrition Labeling Education Act on food product development. The
book is a convenient way for anyone concerned with nutrition
policy to catch up on the topics covered.

This manual provides guidelines for nutritional care practices
at the Mayo Medical Center, but the indications and rationale
behind nutrition interventions are documented to enable other
health care organizations and their nutritionists to adapt it to
their specific needs. It is divided into four parts: normal
nutrition and therapeutic diets for adults; nutritional
management of disease and disorders for adults; normal nutrition
and therapeutic diets for infants, children, and adolescents; and
nutritional management of diseases and disorders for infants,
children, and adolescents.

Chapters on nutritional assessment precede both the adult and
paediatric sections. Other chapters provide summaries of the key
aspects of nutritional intervention or dietary modification, a
section on nutritional inadequacy identifying diet plans that
have the potential for producing nutrient deficiencies if adhered
to for a long time, and sections on indications and rationale for
dietary modifications. The section on the goals of dietary
management is intended as a brief summary of the key objective or
purpose of nutritional intervention. The dietary recommendations
section includes discussions of aspects of assessment that are
unique to a particular disease or disorder and presents specific
guidelines for diet modification and for the development of a
nutritional care plan. Tables summarizing food composition are
provided in many sections, as well as references and other
resources.

This manual will be a useful and authoritative reference tool
for dietitians and medical and health care staff as well as for
students of nutrition and dietetics.

In the introduction to this volume the editor notes that
epidemiologically, the goal of dietary assessment is to quantify
the exposure level of individuals to certain foods or nutrients
over time. It has been argued that "for certain dietary
factors, there is currently no reliable, observational approach
to the assessment of the diet and disease association of major
public health potential." Three paths are outlined and
discussed for nutritional epidemiological research: One is to
devote time and effort to quantifying the errors and inaccuracies
in currently used dietary assessment methods as well as
validating results and estimating the effects of the flaws on the
results. A second path is to concentrate on new technology, e.g.,
computer technology, research in the psychology of questioning,
and the art of interviewing. The third alternative is to turn to
indicators of usual dietary behaviour, the biomarkers of dietary
intake that can be quantified objectively through measurements of
biological samples of blood, hair, saliva, urine, and nails or
through anthropometric measurements. Chapters are included on
each of these pathways, each of which has advantages and
disadvantages. There is also a section summarizing eight
workshops held during the meeting.

The book is intended to provide a forum for airing differences
of opinion regarding the best solutions to the problems of
dietary assessment, with the hope that the interactions and
results will inspire new and innovative approaches to the problem
of accurate, affordable, and rapid methods of assessment of usual
dietary behaviour. It will be a useful reference tool for
nutritionists, dietitians, and other health professionals as well
as epidemiologists who obtain and use dietary intake data.

There have been extensive advances in zinc research in recent
decades, and this comprehensive treatise written by one of the
world's authorities is welcome. The improvement in understanding
zinc metabolism is impressive-for example, from the recognition
of three zinc-dependent enzymes in the 1960s to over 300 today.
Knowledge has been advanced by the recognition of a fatal
genetically induced zinc deficiency, acrodermatitis
enteropathica. The growing number of reports of significant
clinical effects of zinc deficiency in humans are reviewed,
although the weakness of the link is that "diagnostic
criteria for a mild or marginal deficiency of zinc, which appears
to be common ... have yet to be established." The chapter on
assay techniques lays the groundwork for doing so. Other chapters
cover the progress in characterizing the clinical, biochemical,
metabolic, and immunological characteristics of zinc deficiency,
the need for zinc in parenteral hyperalimentation, and the role
of zinc in controlling the compound metalothionein, which is
important for ameliorating heavy metal toxicity. This is a
successful effort to bring together all of the basic knowledge of
zinc function and relate it to the clinical effects of zinc
deficiency. As such it will be useful both to students of
nutrition and biochemistry and to physicians whose practices
involve nutritional and metabolic disorders.

The contributors to these two new books focusing on
antioxidant vitamins are leading vitamin researchers. They
exhaustively review recent breakthroughs in research on vitamins
E and A, with strong emphasis on their antioxidant properties.
Both volumes have good indices. The information they contain will
be of interest to biochemists, nutritionists, physiologists, and
pharmacologists as well as clinicians and public health workers.

Vitamin A in Health and Disease covers the metabolism
of vitamin A (5 chapters), the mechanisms of action of vitamin A
and carotenoids (4 chapters), the role of vitamin A and
carotenoids (4 chapters), and the role of vitamin A in embryonic
development (3 chapters), skin and epithelial cells (2 chapters),
blood cells (2 chapters), vision (1 chapter), reproduction (1
chapter), cancer incidence (1 chapter), deficiency and toxicity
(2 chapters), and requirements (1 chapter). Current research and
knowledge are also well covered.

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